title: Epidemiology, management and outcome of paracetamol poisoning in an inner city emergency department.
abstract: BACKGROUND
  Paracetamol poisoning accounts for just under half of all self-poisoning cases that present to hospitals in England. Treatment with acetylcysteine is routine, yet recommendations regarding its use vary internationally and have recently been revised in England and Wales.
  
  
  METHODS
  Data on all cases of paracetamol poisoning presenting to an adult inner city emergency department between May 2011 and April 2012 were prospectively collected using the Bristol Self-harm Surveillance Register.
  
  
  RESULTS
  Paracetamol overdoses accounted for 44% of adult self-poisoning cases. A quarter (26.9%) of patients required treatment with acetylcysteine and it was estimated that recent changes in treatment guidelines would increase that proportion to 32.6%. Paracetamol concentration was positively associated with the risk of any adverse reaction to acetylcysteine. 22.5% of patients experienced anaphylactoid reactions to acetylcysteine. There was no clear evidence of an association between risk of anaphylactoid reaction and blood paracetamol levels. Patients presenting with blood paracetamol levels greater than 200 mg/L at 4 h post-ingestion were at greater risk of repeat self-harm (HR 2.17, 95% CI 1.11 to 4.21, p=0.033).
  
  
  CONCLUSIONS
  The recent changes in UK treatment guidelines are expected to increase the proportion of our population requiring acetylcysteine by 5.7%. We found no clear evidence that risk of anaphylactoid or more general adverse reaction to acetylcysteine was increased in patients presenting with lower blood paracetamol concentrations. Blood paracetamol level was highlighted as a potentially useful clinical indicator for risk of repeat self-harm.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Carroll
authors.affiliation: Emergency Department, Bristol Royal Infirmary, Bristol, UK Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Benger
authors.affiliation: Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: Bramley
authors.affiliation: Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.affiliation: Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: L
authors.initials: L
authors.lastname: Griffin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Potokar
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000707:Anaphylaxis / Q000139:chemically induced; D000931:Antidotes / Q000009:adverse effects / Q000627:therapeutic use; D019468:Disease Management; D062787:Drug Overdose / Q000188:drug therapy / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014852:Wales
chemical_list: D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D000082:Acetaminophen; D000111:Acetylcysteine
keywords: Clinical Management; Epidemiology; Poisoning, Deliberate Self; Self Harm